When in Doubt, Sit Them Out

When addressing sports injury these days, one of the first issues that come to mind is concussion. Rightly so, concussion is a traumatic brain injury that can have life-long consequences if not recognized and allowed for full healing. It occurs when there is a jolt to the brain from a hard collision to the body or the head. This may result in a stretching and shearing of brain cells which can create chemical and functional changes within the brain. There is no obvious structural damage (this occurs at the cellular level) so an x-ray or CT scan cannot be used to diagnosis this injury. The jolt may result in a loss of consciousness (LOC) but the majority of concussions occur without LOC.

Prevention is what’s important. Using good technique, following good sportsmanship, officials keeping control of a game/match, and using the right protective equipment can help diminish the possibility of injury. However, keep in mind that there is no helmet or piece of equipment that will fully prevent concussion.

If an athlete is involved in a severe collision, look for the following signs/symptoms:
• Headache or a feeling of “pressure” in the head
• Nausea or vomiting
• Balance problems or dizziness
• Changes in vision
• Confusion
• Loss of recall (where they are, what they’re doing)
• Unusual emotional reactions, crying, agitation

If suspected, remove the athlete from play, ensure that the athlete is evaluated by a health professional, make certain the parents are informed to seek medical assessment and clearance, keep the athlete out of play until clearance has been obtained. When in doubt, sit them out.
When the athlete returns, they should be further evaluated by “Return to Play” guidelines. This is a step by step progression to full play.

Baseline: The athlete should not have any lingering concussion symptoms before beginning the process. The athlete can only progress through each level without any further symptom. Minimally, the progression will be one to two weeks. If symptoms return, the athlete must rest and return to baseline (without any symptoms) before starting again.Step 1: light aerobic activity, 5-10 minutes stationary bike, walking, or light joggingStep 2: moderate-intensity jogging, weights, increased level of stationary bikeStep 3: heavy non-contact drills, sprinting, regular weightsStep 4: return to practice, full controlled contactStep 5: return to competition

Failure to allow for full healing of concussion may lead to further, more serious brain injury. Chronic Traumatic Encephalopathy (CTE) is a very severe, cumulative injury that can occur to brain tissue leading to loss of cognitive function, life-long disability, mental illness, and even death.

Playing sports and being physically active is absolutely necessary in a young person’s life. Doing so without injury is entirely possible so long as we provide safety as a virtue above any championship, tournament, or trophy. As always – Play hard, play safe.
For more information on concussion and to access online concussion training, go to the Centers for Disease Control website at http://www.cdc.gov/HeadsUp/index.html
Play hard, play safe!

by Carlos Flores, RN / FCN

If you would like to connect with Carlos Flores to suggest topics or receive personal feedback, he can reach him at cflores@valleychildrens.org.